Role of nurse in developmental psychology, unit 4, psychology B.sc Nursing.

SUPPORTING NORMAL
GROWTH AND
DEVELOPMENT ACROSS
LIFE SPAN
DR. SUMITY ARORA

STAGES OF DEVELOPMENT STAGES
• AGE Infancy 0-1 year
• Early childhood 1-5 years
• Late childhood 6-12 year ( up to the onset of puberty)
• Adolescence 13- 19 years(From the onset of the puberty)
• Early adulthood 20-40 years
• Middle childhood 41-65 years
• Late adulthood or old age 66 years – till death

PRENATAL STAGE:
Physical growth is most rapid in any person’s lifespan in this period. It
consists of 3 stages.
1.Germinal stage (growth of zygote and implantation in the walls of the
uterus)
2.Embryonic stage ( end of the second week to the end of the eighth week-
rapid growth and differentiation of body systems)
3.Foetal stage ( changes in the body form and organs assume their
specialised functions, this stage ends with birth)

PRENATAL STAGE:
Role of nurse
She should educate the mother regarding the following
• Vulnerability to environmental influences like drugs, radiation, malnutrition
and disease is also great in the stage.
• Mother’s age below 16 years and over 35 years are at high risk for
miscarriages, premature births and birth defects.
• Mother’s age above 40 years have a higher risk of Down syndrome

INFANCY
• The period of infancy begins with birth and lasts for 1 year.
• The infant is called a neonate for the first 4 weeks after birth.
PHYSICAL GROWTH
• During the first 12 months the infant shows very rapid motor development and learns to sit, stand and begins to
walk.
• Infant weighs triple from birth weight by 1 year
• Length increases by almost 50 percent from birth.
• Development of the child is complex and varied.
• Infant shows several reflexes and earning perceptual activities that involves active exploration.
• Visual perception develops rapidly, so that the child can make finer discrimination.
• Even sixth month old infants have implicit and explicit memory.

INFANCY
• Cognitive development:
(Piaget) Sensory Motor stage:
• Children explore the world using their senses and ability to move.
• Development of object permanence and understands the concepts of mental images of
people and events.
Psychosocial Development : ( Ericksons View)
• Trust vs Mistrust; • It is purely based on whether their needs are met or not. If their
needs are met, they develop a sense of trust

INFANCY
• Children in Hospital: • Very small children cannot bear to be separated from parents for long. • Bowlby (1951)
argued strongly that disturbances in mental health and personality development resulted from maternal deprivation.
• There is strongly evidence that very small children suffer from a sense of loss, mourning and grief when away from
their mothers
• Role of nurse
• • On admission to hospital, children experience many other distressing events, for example, the fact of being ill, strange
medical and surgical procedures, different daily routines and a variety of unknown people. Nurse should be vigilant and
maintain IPR and rapport with the child as well parent and should make efforts to decrease the distressing experience
• There may be excessive clinging, nightmares and other emotional disturbances.
• Nearly always, the child’s rate of progress both physically and mentally is affected when there is lengthy or repeated
separation from its mother.
• On returning home the child may refuse to recognise his or her mother and remain detached or unresponsive for some
time. It is the nurses’ repsonsiblity to explain during the discharge counselling and explain regarding follow up.
• Bowel and bladder control achieved may be lost after reaching home which is sign of ineffective coping.

INFANCY
• ROLE OF NURSE:
• • The nurse who is taking care of infants must realize that the primary task of an infant is to grow.
• • Growth and development of an infant is all round and also unique.
• The nurse who is taking care of infant should give personal attention as much as possible such as handling,
cuddling, holding and loving. This kind of care will prevent deprivation and helps for healthy all round development.
• Accurate observation of the infant is extremely important.
• Cry and restless movement is the mode of communication for the infant.
• Encourage the parents to comfort the infant and also involve them in providing care.
• During care use sensory soothing measures.
• The children should be given adequate love, affection and care. • The use of force and violence should be avoided in
dealing with the child.

EARLY CHILDHOOD (2-6 YEARS)
physical growth
The growth rate slows in most areas during this period. • The average child becomes two and one half inches taller and
5to 7 pounds heavier during each year of early childhood. • During this period learns to walk, run, jump and balance; he
/she develops fine motor skills and muscular coordination. • He/she also develops sensory perception of size and learns
to speak.
Cognitive growth
• He/she is capable of practical thinking and solving simple problems. • Learns how to dress and care.
• Other important achievements during this period are learning how to use writing tools, identifying letters, numbers
and sounds.
• He/ she experiences emotions of love and hate, jealousy and anxiety. • He / she also learn to tolerate a certain
degree of frustration and disappointment and deal with his/ her own difficulties independently. • Thus it is a period
of rapid physical, intellectual and socio emotional growth.

• Psychology growth –
• Dependency on others: • Child needs parents to assist in completing daily care. • Child expects that everybody
around hi, should love him and give him his entire affection and attention. • He wants love and to be loved and in
this exchange, he totally depends on the mercy of others. - Self assertion • Though the child depend others, but
wants to dominate them. • Child thinks, child always right and all around him, should obey him. • Child thinks that
they are prince without crown and tries to assert themselves all the time in all situations.
• Period of make believe and fantasy:
• Children at this stage live in the world of their own creation.
• • Child has limited potentialities and aspires more than what he can actually get in real life, child compensates
him in fantasy and make – believe. -Selfish and Unsocial:
• • Almost ego – centric and selfish. • Child doesn’t want to share their toys or give any of their possessions to
others, even the love, affection and admiration.
• Child doesn’t care for the social, moral codes and principles and places their self interest at the premium. -
Emotionally unstable: • In this stage, the period of violent emotional experiences.
• • Emotions, at this stage are marked by intensity, frequency and instability.

• Psychological needs of early childhood: • It includes love, recognition, security,
acceptance, Encouragement, protection, discipline, nutrition, etc. Characteristics
of mental development: • Developing Curiosity and questioning attitude •
Intellectually not developed • Time concept is not developed • Sexual
development: • Although the sex organs at this stage are not developed, yet sex
tendency is in a continuous stage of development. •

• ROLE OF A NURSE:
• Tender loving care and physical security continue to be important to the child during
these years. It is important that the children’s routine in hospital resembles normal life
as far as possible. The child’s day should be a well established routine, which includes
a right time for play, stories and bath and for rest. Accurate observation is important
to find out any physical or emotional problems. A cordial relationship should be
established with the young patient by talking to him at his own level such as asking
him his nick name and likes and dislikes.

LATE CHILDHOOD (6-12 YEARS
• Physical growth
• During this period, physical growth is slow and gradual. • The average child grows 2 to 3 inches in height and
gains weighs 3-5 pounds of weight in a year. • Increased muscular development and resistance to fatigue
makes new skills and activities possible. • Children develop much smoother and well co- ordinate muscle
movements during this stage. • They became capable of many muscular activities such as running, swimming,
riding a cycle and throwing or catching. • Writing or reading and the ability to handle language are 2 important
achievements during this stage.
• Cognitive development
• The child is now able to make the fine movements necessary for writing. • His/ Her thinking is more stimulated
by concrete objects and situations, which can be seen. • He/ she cannot handle complex arithmetic problems.
The special features of the behavioural pattern depicting the psychology of children during this age span may
be outlined as below: • Craving for independence • Emotional stability and control • Developing social
tendencies • Realistic attitude • Dormant sexual urge • Demonstrates social tendency • Growing intellectually •
Showing specific interests and aptitudes

• Other psychological needs include: • -love, affection, security, belonging needs
• -Understanding, attention, Physical care • - Needs to exercise his/her muscles
and refine motor co-ordination. • - Protective environment • - Encouragement • -
Discipline, provision for self expression • - Guidance and direction to understand
what kind of behaviour is expected.

• Role of a Nurse: • Love and care, emotional support • Needs guidance and
direction to understand what behaviour is expected from him/her or the rules to
be followed during hospitalization should be clearly explained to them. • Nurses
should be given explanations for procedures and reasons for hospital rules and
policies. • Health teaching should be given directly related to illness or prevention
of illness. • Observation of the child’s physical condition and his behaviour is
important. • The intellectual development of the child can be evaluated by
observing his/her ability to converse and reason, read, write or solve arithmetic
problems. • Games and physical exercises should be given to them.

• Role of a Nurse contdd…
• Provide love and affection. • Te nurse should be patient in dealing with children. • The child should be
encouraged to develop a spirit of independence. • Allow the child to participate in care and help
whenever possible. • Explain the procedure in simple terms and in relation to how it affects the child. •
Give choices whenever possible, but avoid excessive delays. • Praise the child for helping and
attempting to cooperate, never shame the child for lack of cooperation. • Provide privacy from peers
during procedure to maintain self esteem. • Opportunities for play should be provided.
• • Allow the child to choose his/her own play if possible. Drawing and scribbling is excellent for the
child; picture books and puzzles are favoured when the child is old enough. • Games and toys should
be made available in paediatric unit. • Nurses can learn to use play therapeutically. • Small children do
not understand the meaning of sickness very clearly. • The child’s early experiences with sickness, pain,
hospitalization, separation from his/ her mother and being cared for by nurses may influence attitude
to sickness later in life.

ADOLESCENCE (12-19 YEARS)
• Physical growth
• Adolescence is a period of rapid physical, intellectual, emotional and social growth- a
period of growing up.
• • Physically, the boy or girl becomes an adult, sex organs mature. • Adolescence
begins with very rapid changes in the body. •
• Changes in the body can be seen in weight and height, shape of body, sound of
voice, presence of pubic and facial hair and other external sex characteristics.
• The initial spurt in growth usually begins about 2 years earlier in girls than in boys. •
There is intellectual growth towards a mature and abstract mode of thinking.

• Cognitive development
• • Intelligence reaches its maximum. • Emotionally, the adolescent grows
independent from parents and prepares himself for entering into other
relationships that are needed in marriage, work and in the community. • Sex
conscious develops and this influences the emotional as well as the intellectual
activities of the individual. • Biological changes lead to moods, confusion and
worries of all types. • Puberty is the important physical change during
adolescence. • He/she becomes mature or capable or capable of sexual
reproduction. • Endocrine gland regulates puberty through the secretion of
hormones

• • Adolescent girls and boys become very interested in sexual development and in
relationships with members of the opposite sex. • An adolescent has many
variations in mood, variations between excessive bursts of energy and periods of
laziness. • They are extreme sensitive, self- consciousness, desire to be
intellectually and emotionally independent

• SPECIAL FEATURES: • Perplexity with regard to somatic variation • Intensification
of self awareness • Sexually much conscious • Staunch follower of the peer group
values • Inflicted with the conflicting demands of • Independence vs dependence
• Idealism vs realism • Worried about vocational choice and becoming self-
supported
• Psychological needs of an adolescence: • Need for status • Independence •
Satisfying philosophy of life • A proper orientation to the opposite sex and
guidance in selecting vacation.

• Role of a Nurse: • Explain each procedure with rationale • Encourage questions
regarding fears, options and alternativeness. • Discuss how nursing procedures
may affect appearance and what can be done to minimise it. • Accept the
regression to more childish methods of coping. • Allows them to talk. •
Adolescence will most likely be able to make decisions about caring for himself
and planning his health care

EARLY ADULTHOOD (20-40 YEARS) •
• This age span can be considered the healthiest and most energetic time of one’s
life. Biological function and physical performance reach their peak from 20-35
years of age, waning from after 35 years. • During early adulthood, most adults
reach their full height. • A number of sensory and neural functions are also
optimal level during this period. • For women, reproductive capacity is at its peak
during young adulthood. • Intellectual abilities appear to peak during this period.
• Tasks requiring quick response time, short term memory and ability to perceive
complex relations are performed more efficiently during late teens and early
twenties. • Certain creative skills reach highest level during young adulthood.

• • Young women have additional psychological differences related to body
changes.
• • About 75% of all women in young adulthood experience mood swings with the
cycle of menstruation. • These are caused due to hormonal changes in the body.
• Choosing a career and life partner are top priorities in this stage. • Child rearing
is usually an important part of young adulthood. • During this period behaviour is
governed more by intelligence than emotions, adults adapt easily to social
situations, face reality objectively, have normal drive to work or play and act
according to own age. • Adults are vocationally adjusted and are able to think
and decide things on their own.

• Psychological needs of early adulthood: It includes a balance of intimacy,
commitment, freedom and independence. The adult also likes the needs, security,
self- realisation and recognition.
• Development of intimate relationship and status in society.
• Age of making decisions and settling down with respect to Jobs and career,
Relationship and marriage, Size of the family and education of childhood, Role of
status in community.

• Erickson’s View on the psychology view of early adulthood: • Intimacy vs
Isolation: • Seeks to form intimate relationship with opposite sex. • In this marital
relationship, they tend to risk even loss of his ego or image. • If there is failure in
intimate relationship, they tend to loss their relationship and tend to develop
isolation.

• Role of Nurse: • Young adults are rarely hospitalised, usually for childbirth,
injuries or any accident or any problems in digestive tract or genitourinary tract. •
Have to teach and assistance in handling babies. • Explain the personality
characteristics required for parental figure and that should be respected. •
Explanation of procedures. • Assist with problem solving • Help the couples to
achieve intimacy with each other.

MIDDLE ADULTHOOD (40-60 YEARS
• Mid life brings with it dramatic changes in Physical development.
• The slow decline of physical development, which begins during the late years of early
adulthood appears to speed up and is much more visible as a person reaches the late
forties. • In middle age, the skin loses some of the elasticity; hair begins to thin out
and often turns grey or white. • Muscular strength declines slowly, but steadily from
young adulthood onwards. • A major physical change comes about in CVS of a person
in middle life. • Narrowing of coronary arteries may occur for some mid aged persons.
• Cholesterol level rise and begins to collect on the walls of the arteries, which are also
beginning to thicken. • Changes in the reproductive system of men and women

• physical growth contdd….
• • Decreased production of oestrogen and testosterone. • In mid- forties, women
will attain menopause which is associated with a number of unpleasant
symptoms have been appear which includes profuse sweating, hot flushes,
dizziness, head ache, irritability, depression, insomnia and weight gain. • The male
climacteric occurs at about 50 years of age , during which men experience a
gradual decline in testosterone.

• Erickson’s View: • Generativity vs Stagnation: • Needs to satisfy his needs for
generativity, a concern to establish and guide the next generation, this is realized
through nurturing his own children, guiding and directing other young people
and by engaging in some kind of creative, productive or fruitful activity that may
beneficial to society. • Have to participate in the welfare of the future generation.
• Opposite to the above is stagnation.

• Role of nurse: •
• Middle aged is more likely to be hospitalised for cardiovascular problems; BP, cholesterol or
cancer or diabetes. •
• Explain hospital procedures clearly. Nurse should guide the family members in personal
activities of the patient.
• nurse should do Observation of emotional and physical health is necessary to recognise signs
of Physical decline.
• Written instructions by the nurse can be provided when needed.
• Health teaching by nursing personnel is important.
• Nurse should Encourage independency

LATE ADULTHOOD (OLD AGE, 60 YEARS AND
ABOVE)
• Physical growth
• It is the period of retirement from active work. • Marked by impairment of sensory
function (seeing and hearing) . There is a slowing down of motor functions,
besides a gradual impairment in muscular co-ordination. The resistance to
disease and injury diminish • decline in mental ability . Memory, thinking and
ability to learn new things are affected. • Loss in the efficacy of CVS has the
maximum impact upon a person in late adulthood. • Chronic diseases are
common like arthritis, loss of hearing, vision and cancer. • Decrease in social
interaction and increased in aloofness • Symptoms of irritability, short tempered
and anxiety ridden responses in the behaviour.

ABOVE) •
• Psychological needs of late childhood: • Need for improvement of self image, need
for normal roles and relationship. • Need for love and relatedness • Need to improve
sense of hopefulness and need for accomplishments of tasks. Erickson’s View: • Ego
integrity Vs Despair: • Integration or culmination of the successful resolution of all the
seven previous crises in the course of one’s life. • A Person with a developed sense of
integrity is at peace with the life, he has lived and has no major regrets over what
could have been or for what should have been done differently. • Despair: Feel
dissatisfied with the way they lived their lives. • They thought that they have no time
left for changing the course of their lives and doing what should have been done,
makes them feel miserable and consequently, they are doomed to develop a sense of
despair.

ABOVE) •
• Role of a Nurse: • Older adults may be hospitalized more than any other age
group. • Insecurities and apprehension should be relieved • Prepare the patient
about the outcome of terminal illness. • The nurse should assess the patient’s
ability to see, hear, and walk and vital signs. • Closer observation for depression,
poor sleep, lack of coping. • Emotional help is necessary • Physical protection
from harm and injury should be provided. • Health teaching should be provided.
• Memory improving techniques should be followed.

Role of nurse in developmental psychology, unit 4, psychology B.sc Nursing.

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